Alle indlæg af urtehave_com

Instruction

General

SportNetDoc

Instructions.

Rehabilitation begins with the exercises at Step-I. When the exercises at Step-I can be performed without pain (whilst performing the exercises, in the evening or next morning), the exercises at Step-II can be commenced. When the Step-II exercises can be completed without discomfort, the exercises at Step-III can be started, following on to Step-IV.

If any soreness is experienced upon completion of the exercises which gives cause for any doubt as to whether this is due to normal muscle stiffness following training, or more of a “warning” soreness due to the intensity of the training increasing too quickly, the next training session should be performed on the same level.

If the soreness subsequently diminishes, the soreness can be attributed to normal muscle stiffness, and the rehabilitation can be cautiously increased. If, on the other hand, the soreness does not decline, the rehabilitation is being forced too quickly, and the load has exceeded the limit which the injury is capable of managing for the time being. The training load and intensity should consequently be reduced immediately, and training should continue on a lower level for some days before being cautiously increased again.

The amount of time which it is possible to use on the rehabilitation exercises naturally varies greatly from person to person, and the indications given should therefore be considered as a guideline for the relationship between strength, coordination and agility training, and can be amended according to the training opportunities which are available, as well as individual requirements.

The rehabilitation period will generally pass quicker if more training is performed. However, if the guidelines in SportNetDoc go against information from your own doctor, you should naturally follow the advice of the doctor which has examined and evaluated your injury.

The guidelines in Rehabilitation, general should be read before the exercises in Steps I-IV are commenced.

 

Inflammation of the growth plate of the heel bone (apophysitis calcanei)

Inflammation of the bursa at the attachement

BETÆNDELSE VED VOKSEZONEN PÅ HÆLKNOGLEN

Diagnosis: INFLAMMATION OF THE ACHILLES TENDON ATTACHMENT
(Achilles enthesopathy)

Anatomy: The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. The Achilles is attached to the heel bone (calcaneus) where a growth zone is found in children represents the weakest area of the Achilles tendon and calf muscle in non-adult persons.

  1. M. soleus
  2. Tuber calcanei
  3. Tendo calcaneus (Achillis)
  4. M. gastrocnemius

LOWER LEG FROM THE REAR

Cause: Inflammation at the point of attachment of the Achilles tendon at the heel bone occurs with continued overload in the form of running and jumping.

Symptoms: Pain when activating the Achilles tendon (running and jumping) and with stretching of the tendon. Tenderness is experienced when applying pressure at the rear of the heel bone.

Acute treatment: Click here.

Examination: Medical examination is not necessarily required in slight, early cases where the tenderness is slowly increasing without sudden worsening. In all cases when there is a sense of a “crack”, or sudden shooting pains in the Achilles tendon, medical attention should be sought as soon as possible to exclude a (partial) rupture of the Achilles tendon. This situation is best determined by use of ultrasound scanning, as a number of injuries requiring treatment can easily be overlooked during a medical examination. A normal medical examination is usually sufficient in order to make the diagnosis, however, in all cases where satisfactory progress is not in evidence, an ultrasound examination should be performed as early as possible. Ultrasound scanning enables an evaluation of the extent of the change in the tendon; inflammation of the tendon (tendinitis), development of cicatricial tissue (tendinosis), calcification, inflammation of the tissue surrounding the tendon (peritendinitis), inflammation of the bursa (bursitis), as well as (partial) rupture and fraying of the bone membrane, as is often the case in children with inflammation at the point of attachment of the Achilles tendon at the growth zone on the heel bone (Photo) (article).

Treatment: Treatment is primarily comprised of relief from the painful activity (running, jumping). If the treatment is commenced early, the injury can in some cases heal within a few weeks. When the pain has subsided, the sports activity can be resumed preceded by stretching and strength training of the calf muscle. Unfortunately the Achilles problems at the attachment (enthesopathy) are more difficult to treat by (eccentric) training than mid-portion Achilles tendinitis (article). It is naturally crucial that footwear is in good condition (good running shoes with shock absorbing heel and close fitting heel cap). Pressure on the Achilles tendon can be relieved by using shoes with an elevated heel, whilst a heel cushion in the shoe is of less significance since the heightening achieved by this method is greatly limited. If experiencing tenderness at the point of attachment of the Achilles tendon during the rehabilitation period, treatment with ice for a period of at least 20 minutes is recommended. To relieve pronounced pain whilst walking, medicinal treatment in the form of rheumatic medicine (NSAID) (gel or crème) can be considered in the acute stage but is seldom indicated in the chronic stage. Medicine must not be (mis)used in order to continue the sports activity. Injection of corticosteroid is not appropriate in the course of treatment in children (article) but can be used in adults.

Complications: If there is not a steady improvement in the condition an ultrasound scan should be performed to exclude:

x-ray-artical

Slipping of the femoral head in the growth zone

Untitled Document

Diagnostic imaging of the early slipped capital femoral epiphysis.

Magnano GM, Lucigrai G, De Filippi C, Castriota Scanderberg A, Pacciani E, Toma P. Radiol Med (Torino) 1998 Jan-Feb;95(1-2):16-20
INTRODUCTION: Early slipped capital femoral epiphysis (ESCFE) can be treated surgically, with excellent results, if it is diagnosed in its initial stage; however, the rate of late or missed diagnoses remains surprisingly high. PURPOSE: We compared radiography, US and MR sensitivity in ESCFE diagnosis. MATERIAL AND METHODS: We examined 21 symptomatic overweight patients (15 boys and 6 girls) aged 9 to 15 years with anteroposterior radiographs; frog leg images were not acquired in 3 cases only. US was performed in 19 cases and the images acquired with 5-7.5 MHz probes on the sagittal plane parallel to the femoral neck. MRI was performed in 9 cases, with coronal and sagittal T1 SE and T2* GE images. RESULTS: Our sensitivity rates were 66% for anteroposterior radiography (6 false negatives), 80% for combined anteroposterior and frog leg images (3 false negatives), 95% for US (1 false negative) and 88% for MRI (1 false negative). DISCUSSION AND CONCLUSION: We believe that US is the method of choice in ESCFE diagnosis; if it is negative, but pain persists, MRI should be performed.
KONDITION

STEP4

Inflammation of the bursa at the attachement

[Back]

Training ladder for:
SLIMSÆKSBETÆNDELSE VED ACHILLESSENEFÆSTET
(BURSITIS ACHILLES)

STEP 4
It is imperative to ensure that the shoes do not pinch the heel, and have a sound shock absorbing sole.
KONDITION
Unlimited: Cycling. Swimming. Running with increasing distance on a soft surface.

UDSPÆNDING
(10 min)

Stand with the injured leg stretched backwards with the toes facing front. Slowly bend the knee so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with the injured leg outstretched with the ankle joint bent up against the wall. Press your abdomen against the wall so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support on the wall with the hand on the same side. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the big toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn slightly outwards so that increased stretching is experienced on the inside of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support from the wall with the opposite hand. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the little toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn over the good leg so that increased stretching is experienced on the outer side of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(45 min)

Sit on the floor. Tip the foot up and down with elastic under the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot up and down with elastic on top of the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot from side to side with elastic on the outer side of the foot, without moving the knee.

Sit on the floor. Tip the foot from side to side with elastic on the inner side of the foot, without moving the knee.

Stand on a soft surface. Rise slowly up on tiptoe and go down again.

Stand behind a chair. Rise slowly up on tiptoe and go down again.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

STEP3

Inflammation of the bursa at the attachement

[Back]

Training ladder for:
SLIMSÆKSBETÆNDELSE VED ACHILLESSENEFÆSTET
(BURSITIS ACHILLES)

STEP 3
It is imperative to ensure that the shoes do not pinch the heel, and have a sound shock absorbing sole.
KONDITION
Unlimited: Cycling. Swimming. Light jogging on a smooth surface.

UDSPÆNDING
(10 min)

Stand with the injured leg stretched backwards with the toes facing front. Slowly bend the knee so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with the injured leg outstretched with the ankle joint bent up against the wall. Press your abdomen against the wall so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support on the wall with the hand on the same side. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the big toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn slightly outwards so that increased stretching is experienced on the inside of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support from the wall with the opposite hand. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the little toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn over the good leg so that increased stretching is experienced on the outer side of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(45 min)

Sit on the floor. Tip the foot up and down with elastic under the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot up and down with elastic on top of the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot from side to side with elastic on the outer side of the foot, without moving the knee.

Sit on the floor. Tip the foot from side to side with elastic on the inner side of the foot, without moving the knee.

Stand on a soft surface. Rise slowly up on tiptoe and go down again.

Stand behind a chair. Rise slowly up on tiptoe and go down again.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

STEP2

Inflammation of the bursa at the attachement

[Back]

Training ladder for:
SLIMSÆKSBETÆNDELSE VED ACHILLESSENEFÆSTET
(BURSITIS ACHILLES)

STEP 2

 
It is imperative to ensure that the shoes do not pinch the heel, and have a sound shock absorbing sole.
KONDITION
Unlimited: Cycling. Swimming. Running in deep water.

UDSPÆNDING
(10 min)

Stand with the injured leg stretched backwards with the toes facing front. Slowly bend the knee so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with the injured leg outstretched with the ankle joint bent up against the wall. Press your abdomen against the wall so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support on the wall with the hand on the same side. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the big toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn slightly outwards so that increased stretching is experienced on the inside of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support from the wall with the opposite hand. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the little toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn over the good leg so that increased stretching is experienced on the outer side of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(45 min)

Sit on the floor. Tip the foot up and down with elastic under the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot up and down with elastic on top of the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot from side to side with elastic on the outer side of the foot, without moving the knee.

Sit on the floor. Tip the foot from side to side with elastic on the inner side of the foot, without moving the knee.

Stand on a soft surface. Rise slowly up on tiptoe and go down again.

Stand behind a chair. Rise slowly up on tiptoe and go down again.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

STEP1

Inflammation of the bursa at the attachement

[Back]

Training ladder for:
SLIMSÆKSBETÆNDELSE VED ACHILLESSENEFÆSTET
(BURSITIS ACHILLES)

STEP 1
It is imperative to ensure that the shoes do not pinch the heel, and have a sound shock absorbing sole.

The indications of time after stretching, coordination training and strength training show the division of time for the respective type of training when training for a period of one hour. The time indications are therefore not a definition of the daily training needs, as the daily training is determined on an individual basis.
KONDITION
Unlimited: Cycling. Swimming.

UDSPÆNDING
(10 min)

Stand with the injured leg stretched backwards with the toes facing front. Slowly bend the knee so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with the injured leg outstretched with the ankle joint bent up against the wall. Press your abdomen against the wall so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support on the wall with the hand on the same side. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the big toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn slightly outwards so that increased stretching is experienced on the inside of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand on the good leg while gaining support from the wall with the opposite hand. Bend the knee of the injured leg and draw the heel towards the buttocks. Take hold of the little toe side of the foot and draw slowly upwards so that the ankle joint is stretched to the maximum and drawn over the good leg so that increased stretching is experienced on the outer side of the shin bone. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(45 min)

Sit on the floor. Tip the foot up and down with elastic under the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot up and down with elastic on top of the forefoot so that the elastic becomes taut.

Sit on the floor. Tip the foot from side to side with elastic on the outer side of the foot, without moving the knee.

Sit on the floor. Tip the foot from side to side with elastic on the inner side of the foot, without moving the knee.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

Treatment-a2

Inflammation of the bursa at the attachement

SportNetDoc

Surgical management of Achilles tendon overuse injuries. A long-term follow-up study.

Schepsis AA, Wagner C, Leach RE. Am J Sports Med 1994 Sep-Oct;22(5):611-9.

We studied 79 cases of surgically treated Achilles tendon overuse injuries in 66 patients. Fifty-three (80%) of these patients were competitive or serious recreational runners operated on between 1978 and 1991. There were 49 men and 17 women with a mean age of 33 years (range, 17 to 59). The cases were divided into surgical subgroups based on their site of primary symptoms and abnormalities: paratenonitis (23), tendinosis (partial rupture or degeneration) (15), retrocalcaneal bursitis (24), insertional tendinitis (7), and combined abnormalities (10). Followup included a comprehensive patient questionnaire and office examination. There were 79% satisfactory (51% excellent, 28% good) and 21% unsatisfactory (17% fair, 4% poor) results. The percentages of satisfactory results in the paratenonitis group (87%) were best and those in the tendinosis group were the worst (67%). Satisfactory results were obtained in 75% of the patients with retrocalcaneal bursitis and 86% with insertional tendinitis. Seven of the 45 cases with longer than 5-year followup with initially satisfactory results deteriorated with time and required reoperation (16%). Of these, 4 were in the tendinosis group, 2 had retrocalcaneal bursitis, and 1 had paratenonitis. One of the 34 patients followed less than 5 years required reoperation.

Treatment-a1

Inflammation of the bursa at the attachement

SportNetDoc

Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional achilles tendinosis with calcific spur.

Watson AD, Anderson RB, Davis WH. Foot Ankle Int 2000 Aug;21(8):638-42.

Sixteen feet with retrocalcaneal bursitis (RB) and twenty-two feet with calcific Achilles insertional tendinosis (IAT-CS) underwent retrocalcaneal decompression after failure of nonoperative treatment. Follow-up evaluation at least two years after surgery included AOFAS Ankle-Hindfoot subscale scores, satisfaction, time until maximum symptomatic improvement, and radiographs. Statistically significant differences between the groups include the following: IAT-CS patients were older, required nearly twice the time to reach maximum symptomatic improvement, had lower satisfaction rates, had a lower pain score, and more frequently had shoewear restrictions. Radiographic recurrence did not correlate with outcome or symptomatic recurrence.